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J Wrist Surg
DOI: 10.1055/a-2710-9610
Scientific Article

Screening Criteria for Amyloidosis Biopsy Testing during Carpal Tunnel Release in Community Hospitals: Evaluation and Application

Authors

  • Michael E. Sacchetti 

    1   Central Michigan University College of Medicine, Saginaw, Michigan, United States

  • Shivam Desai

    1   Central Michigan University College of Medicine, Saginaw, Michigan, United States

  • Bradley Hunt

    1   Central Michigan University College of Medicine, Saginaw, Michigan, United States

  • Charles Keane

    2   Department of General Surgery, Central Michigan University College of Medicine, Saginaw, Michigan, United States

  • Asef Hoque

    1   Central Michigan University College of Medicine, Saginaw, Michigan, United States

  • Beth Bailey

    1   Central Michigan University College of Medicine, Saginaw, Michigan, United States

  • Anthony Zacharek

    3   Covenant Healthcare, Saginaw, Michigan, United States

Funding Information None.
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Abstract

Background

Carpal tunnel syndrome (CTS) is a common disorder caused by median nerve compression. Current research has explored the relationship between CTS and cardiac amyloidosis, which can lead to poor health outcomes, highlighting the need for screening guidelines. Although recommendations exist for when to biopsy during carpal tunnel release (CTR), studies have primarily focused on urban or academic centers. This study evaluates these recommendations in a community hospital setting serving a predominantly rural population.

Materials and Methods

This retrospective study assessed risk factor based screening recommendations for intraoperative tenosynovial biopsy during open CTR. All procedures were performed by a single plastic surgeon. Positive Congo red staining samples were sent to the Mayo Clinic for confirmatory testing. Positive and negative amyloidosis cases were compared, with analyses stratified based on associated risk factors.

Results

The study included 105 patients (47.6% female) with a median age of 66.0 years old. Of these, 9.5% (n = 10) tested positive for amyloidosis. The median age of those who tested positive for amyloidosis was 81.5 years, compared with 65.0 years in those who tested negative. Of the 10 positive cases for amyloidosis, 7 patients had a history of chronic kidney disease (CKD), and 6 patients tested positive for the ATTR subtype.

Conclusion

With an overall amyloidosis positivity rate of 9.5%, this falls within range of previously reported positivity rates. Given the community hospital setting, ensuring follow-up is crucial, especially to determine if a positive result warrants amyloidosis treatment. Strong collaboration between hand surgeons and specialists is essential for coordinated local or tertiary care follow-up.

Keywords

amyloidosis - carpal tunnel syndrome - carpal tunnel release - screening - community hospital

Ethical Approval

This study received ethical approval from the Covenant HealthCare IRB (approval #2084516–3) on August 8, 2023. This is an IRB-approved retrospective study; all patient information was de-identified and patient consent was not required. Patient data will not be shared with third parties.


Informed Consent

Informed consent for information published in this article was not obtained because of the approval by the Covenant HealthCare Institutional Review Board for a retrospective study.




Publikationsverlauf

Eingereicht: 28. Juli 2025

Angenommen: 26. September 2025

Artikel online veröffentlicht:
14. Oktober 2025

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